Federal Tax ID (EIN)

IMPORTANT: The IRS will not issue an EIN unless the name of the principal officer and the SSN match exactly. Please use the name exactly as it appears on the SSN card.

(*) Indicates a required field.

Name of Entity*
Trade Name of Business
Only if different than line 1
"Care of" Name
Mailing*
Street Address Address Line 2 City State ZIP Code
Is your Physical Address different than your Mailing Address?*
- Yes
- No
Physical Address
Street Address Address Line 2 City State ZIP Code

Physical address of business
Name of Principal Officer*
First Last
Social Security Number of Principal Officer*
Please no spaces or special characters allowed.
Type of Entity*
- Corp
- Professional Corp
- LLC

Number of Members in the LLC
Are any of the members' husband and wife
- Yes
- No
If members' are husband and wife select one of the following
- We elect to be classified as a multi-member LLC
- We elect to be classified as a single-member LLC
Names of ALL Members

Please list all members on different lines
Have you applied or will you be applying for Subchapter "S" status?*
- Yes
- No
State where incorporated*
Date Business Started*
Closing Month of Accounting Year*
First date wages were or will be paid*
Highest number of employees within next 12 months*
Principal Activity*

Please be specific

Has applicant ever applied for an EIN before?*
- Yes
- No
Provide legal name on previous application
Provide the trade name on previous application
Date when filed
City where filed
State where filed
Previous EIN
Name of Person Signing SS-4*
Title of Person Signing SS-4*
Business Telephone Number*
Facsimile Number*

Authorize
I hereby authorize and direct Allen Corporation Supply to complete, affix my signature to, and file an IRS SS-4 form on my behalf, in order to secure an Employer Identification Number for my new entity.
Date*
Signature*
First Last

Step 1 of 4

Authorize